Effect of antidepressant drug counselling and information leaflets on adherence to drug treatment in primary care: randomised controlled trial

Abstract

Objectives: To evaluate two different methods of improving adherence to antidepressant drugs. Design: Factorial randomised controlled single blind trial of treatment leaflet, drug counselling, both, or treatment as usual. Setting: Primary care in Wessex Participants: 250 patients starting treatment with tricyclic antidepressants. Main outcome measures: Adherence to drug treatment (by confidential self report and electronic monitor); depressive symptoms and health status. Results: 66 (63%) patients continued with drugs to 12 weeks in the counselled group compared with 42 (39%) of those who did not receiving counselling (odds ratio 2.7, 95% confidence interval 1.6 to 4.8; number needed to treat=4) Treatment leaflets had no significant effect on adherence. No differences in depressive symptoms were found between treatment groups overall, although a significant improvement was found in patients with major depressive disorder receiving drug doses of at least 75 mg (depression score 4 (SD 3.7) counselling v 5.9 (SD 5.0) no counselling, P=0.038). Conclusions: Counselling about drug treatment significantly improved adherence, but clinical benefit was seen only in patients with major depressive disorder receiving doses ≥75 mg. Further research is required to evaluate the effect of this approach in combination with appropriate targeting of treatment and advice about dosage. Non-adherence is a serious problem in the treatment of depression by general practitioners In this study a brief psychosocial intervention delivered by a nurse greatly improved adherence Clinical benefit was apparent only in patients with major depressive episodes on higher doses of drugs Counselling should be targeted at patients with symptoms of at least moderate severity and combined with therapeutic drug doses